In Illinois, uninsured women now waiting for mammograms

Betty Daniel

Heather Charles, Chicago Tribune

Betty Daniel, of Chicago, gets her routine yearly mammogram from lead mammography tech Stella Palmer at Mount Sinai Hospital in Chicago on Wednesday. Daniel said she feels fortunate to have mammography coverage through Medicaid. “I wouldn’t feel good if I had to wait,” she said afterward. “It...

Betty Daniel, of Chicago, gets her routine yearly mammogram from lead mammography tech Stella Palmer at Mount Sinai Hospital in Chicago on Wednesday. Daniel said she feels fortunate to have mammography coverage through Medicaid. “I wouldn’t feel good if I had to wait,” she said afterward. “It... (Heather Charles, Chicago Tribune)

Laurie Linke is due for a screening mammogram, but she might not get one anytime soon. After filling out forms that qualified her for a state program for uninsured women, she was placed on a waiting list.

Linke was counting on getting a free mammogram because she doesn't have a job, her unemployment benefits have run out, and she has exhausted her savings. Laid off from her position as a sales executive for a mortgage company in 2008, she said even a low-cost mammogram is beyond what she can afford right now.

But halfway through the fiscal year, the program she turned to, the Illinois Breast and Cervical Cancer Program, is running out of money and unable to fund screening mammograms coordinated at five sites in the Chicago area, plus seven in other parts of the state.

"I'm frustrated," said Linke, 45, who lives in Homewood. "I think if we had universal health care a lot of people wouldn't have to neglect their health because they don't have insurance."

A national uproar erupted recently over access to breast cancer screening after charity giant Susan G. Komen for the Cure, which funds organizations and programs that provide mammograms to uninsured and underinsured women, announced that it would no longer give money to Planned Parenthood. That decision was quickly reversed, but in Illinois, access to mammograms, Pap smears and other reproductive health services remains an issue for many uninsured women.

The Illinois Breast and Cervical Cancer Program was created to help women who don't qualify for services through Medicaid or Medicare. To participate in the program, women must be uninsured or have health insurance that specifically excludes screening services. Although many work, they are self-employed, work part time or are not offered health insurance through their jobs.

"This is for women who completely fall through the cracks," said Shannon Lightner, deputy director of the Office of Women's Health at the Illinois Department of Public Health, which oversees the program.

Screening mammograms help identify breast cancer in its early stages, when it is most easily treated and least likely to be life-threatening. As of January, nearly 155,000 women have been screened for breast and cervical cancers since the early detection program was launched in Illinois in 1995. In the last fiscal year the number of screenings was about 40,000.

One reason for the funding crunch is greater demand as the number of uninsured women rises and public awareness grows about the need for mammograms. Another is the higher cost of performing digital mammograms, now the standard screening tool.

Gov. Pat Quinn cut the budget for the screening program, which receives about $20 million in state and federal funding, by about $1 million for the current fiscal year, which ends June 30.

To stretch the budget, about 400 women a month who qualify will be placed on waiting lists statewide. Women who show symptoms of breast cancer or who have had abnormal mammograms will be able to get mammograms at all locations, Lightner said.

"Overall, women are finding that it's getting harder and harder to schedule mammograms," said Anne Marie Murphy, executive director of the Metropolitan Chicago Breast Cancer Task Force. "They may find it hard to get through on the phone lines. They may find delays in scheduling breast exams or get wait-listed for a mammogram. ... This is really discouraging to women trying to get an essential life-saving service."

"That puts us in a tough situation," said Eileen Knightly, director of women's health and the comprehensive breast cancer center at Mercy Hospital and Medical Center in Chicago. "If it wasn't for the state breast and cervical cancer program and Komen dollars, there are very few ways to take care of the uninsured population. Philanthropy is the only way we can address the screening needs for these patients."

Mercy is the screening program's largest site in the state, serving about 3,500 to 4,000 women a year.

Last May, Komen's Chicago affiliate distributed $1.5 million to 22 organizations and programs in Cook, Kane, DuPage, McHenry and Lake counties that provide mammograms to uninsured and underinsured women. Planned Parenthood performs clinical breast exams, pelvic exams and other services but refers women to other agencies for free or low-cost mammograms.

Mammograms are available at some federally qualified health centers on a sliding fee scale. Organizations including the American Cancer Society, Susan G. Komen for the Cure and the Metropolitan Chicago Breast Cancer Task Force list referral agencies on their websites.

Women aged 19 to 44 who meet income and other eligibility requirements can get mammograms, if they are ordered by the doctor during a family planning visit, at no cost through Illinois Healthy Women, a state program designed to provide family planning services to women of reproductive age.

But advocates and health officials say the state screening program helps the largest number of uninsured women, by far. It's more than just getting a free mammogram, Lightner said. The program offers a full range of services, including breast exams, Pap smears and pelvic exams.

"What we're asking for is $5 million (for the rest of the fiscal year)," said Knightly, vice president of the Metropolitan Chicago Breast Cancer Task Force. "It sounds like a lot right now but I can tell you that while there might be programs where there is waste, there's no waste in this one. … Five million will absolutely make a big difference."

They also are asking the governor to allocate $25 million for fiscal year 2013.

State officials say that they are sympathetic but that difficult decisions have to be made.

"I think there's reason for concern," Lightner said. "We would hate to find out a woman pulled off our priority list had something that wasn't detected at an earlier stage. But we have a fiscal crisis in the state, so not everything can be kept going at the same rate."

For uninsured women, a mammogram averages about $150 out-of-pocket, plus the cost of a clinical breast exam, about $40, Murphy said.

"What's scary for women is that they might need an ultrasound or an extra view (mammogram image), and you could end up with a significantly larger bill than expected," Murphy said.

Health officials say they don't know if the federal Affordable Care Act will make the screening program obsolete. Lightner said some women likely will remain uninsured even after implementation of health care reform over the next several years.

Access to breast cancer screening is a life-and-death issue for low-income women, who are disproportionately African-American, said Steve Whitman, director of Sinai Urban Health Institute in Chicago.

According to the most recent data, the breast cancer death rate for African-Americans was 61 percent higher in Chicago than for white women, a threefold increase since 1990. That translates to 76 black women in Chicago dying every year who would not have died if they were white, Whitman said.

"To make cutbacks in programs that strike at the poorest of women, is, in my opinion, obscene," Whitman said.

These health organizations and agencies can direct you to a health facility to get a mammogram. Some facilities charge on a sliding scale; others provide them for free or at a discounted rate. There may be income criteria or other eligibility requirements.

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